Provider Demographics
NPI:1942338561
Name:MANGAT, HARDEV SINGH (DDS)
Entity Type:Individual
Prefix:
First Name:HARDEV
Middle Name:SINGH
Last Name:MANGAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 TULLY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2541
Mailing Address - Country:US
Mailing Address - Phone:408-272-2424
Mailing Address - Fax:408-272-0958
Practice Address - Street 1:1625 TULLY RD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2541
Practice Address - Country:US
Practice Address - Phone:408-272-2424
Practice Address - Fax:408-272-0958
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice